Affidavit Request - Missouri Beneficiary Deed

Affidavit As To Death of Owner

Request Form

Deceased Owner's Name as set forth in original Warranty Deed (send copy of such deed):

__________________________________________________________________

Date of Death of Owner (send copy of Death Certificate):

__________________________________________________________________

Relationship of Deceased Owner to Surviving Owner:

_________________________________________________________________

Missouri County Where Real Property is Located:

_________________________________________________________________

Missouri City Where Real Property is Located:

_________________________________________________________________

Your Full Name:

_________________________________________________________________

Your relationship to Surviving Owner: _______________________

Your Mailing Address:

______________________________________________________________

Your Telephone Number:

_______________________________________________________

Your Signature:

_______________________________________________________

By signing above you agree this form will serve as the written agreement between yourself and Michael J. Denk, Attorney at Law, to provide the legal services required to draft and provide you with one (1) Affidavit As To Death of Owner at the cost of $50.00 per Affidavit. The filing/recording of your Affidavit and the filing fee as charged by the appropriate Recorder of Deeds office will be your responsibility. No other legal services are being provided. If you have any questions or concerns please contact us prior to signing and returning this form. Thank you.

Fill in all information on this form and mail with a copy of the Beneficiary Deed

and copy of the Grantor's Death Certificate to our office:

Missouri Beneficiary Deed c/o

Michael J. Denk, Attorney at Law

P.O. Box 6464, Chesterfield, MO 63006

_______________________________________________________________________

Affidavit As To Death of Grantor

Request Form

Grantor Name as set forth in Beneficiary Deed (send copy of Beneficiary Deed):

__________________________________________________________________

Date of Death of Grantor (send copy of Death Certificate):

__________________________________________________________________

Grantee(s)/Beneficiary(ies) Name(s) as set forth in Beneficiary Deed:

___________________________________________________________

Grantee Mailing Address (address for one Grantee, no P.O. Boxes):

_________________________________________________________________

Missouri County Where Real Property is Located:

______________________________________________________________

Missouri City Where Real Property is Located:

______________________________________________________________

Your Full Name:

______________________________________________________________

Your relationship to the Grantor: _________________________

Your Mailing Address:

______________________________________________________________

Your Telephone Number:

_______________________________________________________

Your Signature:

_______________________________________________________

By signing above you agree this form will serve as the written agreement between yourself and Michael J. Denk, Attorney at Law, to provide the legal services required to draft and provide you with one (1) Affidavit As To Death of Grantor at the cost of $50.00 per Affidavit. The filing of your Affidavit and the filing fee as charged by the appropriate Recorder of Deeds office will be your responsibility. No other legal services are being provided. If you have any questions or concerns please contact us prior to signing and returning this form. Thank you.

Fill in all information on this form and mail with a copy of the Beneficiary Deed

and copy of the Grantor's Death Certificate to our office:

Missouri Beneficiary Deed c/o

Michael J. Denk, Attorney at Law

P.O. Box 6464, Chesterfield, MO 63006